In
discussing the spiritual needs of the dying from the Buddhist perspective,
we firstly need to look at several key points, namely :

gaining
an understanding of the shortness and preciousness of life.

considering
what can help ourselves and others at the same time of death.

considering
what goes on after death.

the
Buddhist concept of mind.

Reflections
On Death

In
order to gain an understanding of the shortness and preciousness
of life and how to make it meaningful we need to reflect on the
fact that death is certain and that the time of death is uncertain.
These points may seem obvious but we rarely stop to consider the
truth of them.

For
example, when we consider that death is certain we can reflect on
several points:

1)
there is no possible way to escape death (nobody ever has),

2)
life has a definite, inflexible limit and each moment brings us
closer to the end of this life, and

3)
death comes in a moment and it's time is unexpected (and even while
alive we devote very little of our life to spiritual practice).

When
reflecting on the fact that the time of death in uncertain we can
analyse this further by recognising that:

1)
the duration of our lifespan is uncertain - young people can die
before old people, the healthy before the sick, etc.

2)
there are many causes and circumstances that lead to death but few
that favour the sustenance of life - in fact even the things that
sustain life and make it comfortable can kill us e.g. food, our
house, our car.

3)
the weakness and fragility of our body contributes to life's uncertainty
-

our
body can be easily destroyed by disease or accident.

Reflecting
on these points can help us to realise that life is short and precious
and that there is no time to lose. It is good to remind ourselves
of these points each day. It can be very helpful when first getting
up each day to say to ourselves "today may be the last day
of my life, let me live it therefore by making it as meaningful
as possible, being of benefit to others, etc.".

It
can also be very helpful to consider how we would react if we were
told, for example, that we only had 3 or 6 months to live, to ask
ourselves questions like:

am
I ready to die?

what
unfinished business do I have?

what
do I want to do or achieve in the time I have left?

will
my priorities change?

what
can help me at the time of death?

or
as somebody put it "Live each day as though it were your
last and one day you'll be right!"

The
other critical point is to consider what will help us at the time
of death. Reflection here reveals that:

1)
worldly possessions such as wealth, position or money can't help
us

2)
relatives and friends can neither prevent death nor go with us

3)
even our own precious body is of no help to us and we have to leave
it behind.

So
ultimately the only thing that can help us is the state of our mind,
the state of our mental or spiritual development.

Karma
and the mind

How
is this so? The Buddhist belief is that every action of body, speech
and mind that we create lays down a subtle imprint in our mind which
has the potential to ripen as future happiness or suffering, depending
on whether the action was positive or negative. These imprints remain
in the mind until they ripen or until they are purified or cleansed
by spiritual practices. This process in known as the law of karma.

The
mind itself is formless, shapeless, colourless, genderless, and
has the ability to know or cognize all phenomena. It's basic nature
is luminous and knowing. The mind also has different levels - gross,
subtle, and very subtle. The very subtle mind is very clear and
is usually only experienced at the time of death or during advanced
meditation practices. The imprints of our actions (karmic imprints)
are stored in the very subtle mind.

Death,
intermediate state and rebirth

At
the time of death, the body and mind go through a process of dissolution,
where the 25 psycho-physical constituents that we are comprised
of gradually absorb and lose their ability to function. [1] This
process of dissolution is associated with external and internal
signs. This process continues even after the breathing ceases, for
up to 3 days.

During
this process the mind becomes more and more subtle and clear until
it eventually reaches the point of the 'clear light of death', where
it is said to be approximately 9 times more clear than in the normal
waking state. At this point the mind separates from the body, taking
with it all of the subtle imprints from that life and previous ones.

This
very subtle mind or consciousness and the very subtle wind upon
which it rides then arises into an intermediate state (bardo) being
which has a subtle (non-physical) body that can move through solid
objects, travel anywhere just by thinking of that place, and so
on. The intermediate state being stays in that state for up to 7
weeks, by which time a suitable place of rebirth is usually found.
This place of rebirth is determined by the force of karma, whereby
the intermediate state being dies and the consciousness is propelled
without control towards the place of rebirth. The consciousness
enters the fertilized egg at or near the moment of conception and
the new life begins.

Crucial
in this whole process is the state of mind at the time of death,
because it is this that determines the situation a person will be
reborn into. If the mind is calm and peaceful and imbued with positive
thoughts at the time of death, this will augur well for a happy
rebirth. However, if the mind is in a state of anger or has strong
desire or is fearful etc, this will predispose to an unhappy or
lower type of rebirth.

The
mind that arises at the time of death is usually the one that the
person is most habituated to. People tend to die in character, although
this is not always so. So in the Buddhist tradition it is emphasised
strongly that the time to prepare for death is now, because if we
develop and gain control over our mind now and create many positive
causes we will have a calm and controlled mind at the time of death
and be free of fear. In effect, our whole life is a preparation
for death and it is said that the mark of a spiritual practitioner
is to have no regrets at the time of death. As a friend of mine
said recently on hearing about these concepts, "Perhaps it's
time I started swotting for the finals!"

The
Spiritual Needs of the Dying

When
considering the spiritual needs of the dying, the basic principle
is to do whatever you can do to help the person die with a calm
and peaceful mind, with spiritual/positive thoughts uppermost. This
is because it is believed that the state of mind at the time of
death is vitally important and plays an important role in determining
what will happen to the person after death.

So
whether we are a doctor or nurse relieving pain and other distressing
symptoms and reassuring the family, a counsellor helping to resolve
emotional issues, a minister of religion offering spiritual counsel,
or a volunteer who offers companionship and support for the dying
person and their loved ones, we are all contributing significantly
towards obtaining this calm and peaceful state of mind.

Within
this basic principle, there are several ways we can categorise people
which will help to determine the type of spiritual support that
they need, namely:

Is
the person conscious or unconscious?

if
conscious, you can do the practices with them or get them to do
them

if
unconscious, you have to do the practices for them

Does
the person have specific religious beliefs or not?

if
religious, remind them of their religious practices

if
not religious, encourage them to have positive thoughts, or remind
them of positive things they have done

For
a person with a spiritual faith it is beneficial to have spiritual
objects around them e.g. an altar, a rosary, photos of their spiritual
teacher, or to play spiritual music, or to burn incense, and so
on - whatever reminds them of their spiritual practice. It is good
also to talk to them about their spiritual practices, recite prayers
with them and so forth. For an unconscious person it is said to
be good to recite prayers, mantras etc into their ear.

If
a person does not have a spiritual faith, it is helpful to remind
them of positive things they have done in their life, or of positive
qualities such as love and compassion and kindness.

It
is important to avoid religious activities that are inappropriate
or unwanted by the dying person. Someone standing at the end of
the bed reciting prayers may be an annoyance, and I have seen a
case of an attempted deathbed salvation which greatly angered the
dying person.

The
basic aim is to avoid any objects or people that generate strong
attachment or anger in the mind of the dying person. From the spiritual
viewpoint it is desirable to avoid loud shows of emotion in the
presence of the dying person. We have to remind ourselves that the
dying process is of great spiritual importance and we don't want
to disturb the mind of the dying person, which is in an increasingly
clear and subtle state. We have to do whatever we can to allow the
person to die in a calm/happy/peaceful state of mind.

Meditations
for sick and dying people

For
those who have advanced illness but are still conscious there are
a number of simple meditation techniques or visualisations that
can be very helpful.

For
those who are anxious or fearful of dying, teaching them relaxation
or guiding them through a simple relaxation technique can be very
beneficial. I will usually leave them a relaxation tape that they
can use any time of day or night, whenever the need arises. When
appropriate, touch, massage, reflexology and similar techniques
can also be very soothing and stress-relieving, especially as the
person may be somewhat starved of touch due to the fears and awkwardness
of people who visit them.

A
simple meditation technique that is very effective is awareness
of the breath. The person becomes aware of the movement of the breath
inwards and outwards at the level of the nostrils, breathing naturally
and easily, not forcing or exaggerating the breath. At the same
time, any thoughts that arise are let go of, constantly bringing
the mind back to the breath. This technique, although simple, can
generate very calm states of mind and relieve anxiety.

When
the awareness of breath is then combined with the recitation of
certain words or mantras or prayer it becomes very powerful. Just
to say "Let...go...let...go..." in time with the in and
out breaths can be soothing and relaxing. A person with a spiritual
belief can use a prayer or mantra with the breath. For example,
one lady whom I was visiting who was an ex-Catholic nun chose the
prayer "not mine, Lord, but thy will be done". She shortened
this by reciting "Not my will" on the in-breath and "but
yours" on the out-breath, repeating this over and over again.

The
beauty of this technique is that 1) it can be done for short periods
of time and requires little concentration, which is often reduced
by the effects of disease and medication, 2) it helps to calm the
mind and reduce anxiety, 3) it utilizes and strengthens the person's
spiritual refuge, 4) it does not require anything other than the
breath.

For
both a religious and a non-religious person a white light 'healing'
meditation can bring a lot of comfort and benefit. The person visualizes
a brilliant ball of white light above their head, with the light
streaming down through their bodies, removing sickness, pain, fear,
anxiety and filling the body with blissful healing light energy.
Depending on the person's belief system, they can see the light
as being in the nature of Jesus, or Buddha or some other spiritual
figure, or they can just visualise it as a source of universal healing
energy. This meditation combines very well with the breath awareness
technique and is also good to have on tape to leave with the person,
to be used whenever needed day or night. When a person is close
to death they can also be encouraged to let go into the light, into
the heart of Jesus or Buddha seated above their head, whatever is
appropriate for that person.

The
use of guided imagery or gentle music can also be soothing and relaxing
and help the person to have a calm and peaceful mind as they approach
death.

A
person in pain can also be guided through a pain meditation, a technique
whereby the pain is explored in detail, often leading to a reduction
or eradication of the pain. [2] A very profound meditative technique
is to actually use the illness or pain as a way of developing compassion.
For those who can use this technique the results can be very great.
The person is encouraged to think that "by me experiencing
this cancer/AIDS/pain etc, may all other beings in the world be
free of this, and may they have good health, happiness and long
life". The person uses their sickness or pain as a way of opening
their heart to others who are in a similar situation. People who
have used this technique have often gone from being totally caught
up in their own misery to a state of open-heartedness and peace.

An
even more advanced technique is the meditation on "taking and
giving on the breath" as described in the Tibetan Buddhist
scriptures. In this meditation, one visualises taking on the suffering
of all other living beings (or this could be restricted to those
with cancer or AIDS etc) in the form of black smoke, which is taken
in on the in-breath. Then on the out-breath all of our health and
happiness and all positive qualities are sent out to other living
beings in the form of white light, and we visualise them receiving
everything that they want. At our heart we visualise a black rock
of selfishness, and as the black smoke is inhaled we visualise it
hitting the black rock and smashing it completely, thus eradicating
all trace of selfishness from our minds.

This
meditation is a profound method for developing compassion quickly
but there will only be a minority of patients who will be able to
use this method. The usual way to progress in these meditations
is to start with small problems such as a headache or tiredness
etc, then gradually train our minds to transform bigger and bigger
problems.

Conclusion

The
aim of all these methods is to help the dying person die with a
calm, happy and positive mind. Anything that we can do to achieve
this will benefit the person, whether that be good nursing care
and pain relief, massage, the presence of a loving family, or whatever.
It is said that the best thing we can bring to a dying person is
our own quiet and peaceful mind.

In
this way we will help the dying person make the transition from
this life to the next as smooth and as meaningful as possible, recognising
the vital spiritual importance of this transition.

My
wish is that this short paper may in some way be of benefit to those
who read it and reflect on it, and hence to the sick or suffering
people that you serve.

Last
revised August 1995

REFERENCES

Fremantle,
Francesca and Chogyam Trungpa, The Tibetan Book of the Dead: The
Great Liberation Through Hearing in the Bardo, Shambala, Boulder
and London 1975.

(or
the new translation by Robert A.F. Thurman, Aquarian Press, London,
1994)

Kapleau,
Philip, The Wheel of Life and Death, Doubleday, New York, 1989.